Community-based DOTS and family member DOTS for TB control in Nepal: costs and cost-effectiveness.
BACKGROUND
Two TB control strategies appropriate for South Asia (a community-based DOTS [CBD] strategy and a family-based DOTS [FBD] strategy) have been shown to be effective in Nepal in meeting the global target for the proportion of registered patients successfully treated. Here we estimate the costs and cost-effectiveness of the two strategies. This information is essential to allow meaningful comparisons between these and other strategies and will contribute to the small but growing body of knowledge on the costs and cost-effectiveness of different approaches to TB control.


METHODS
In 2001-2, costs relating to TB diagnosis and care were collected for each strategy. Structured and semi-structured questionnaires were used to collect costs from health facility records and a sample of 10 patients in each of 10 districts, 3 using CBD and 2 using FBD. The data collected included costs to the health care system and social costs (including opportunity costs) incurred by patients and their supervisors. The cost-effectiveness of each strategy was estimated.


RESULTS
Total recurrent costs per patient using the CBD and FBD strategies were US$76.2 and US$84.1 respectively. The social costs incurred by patients and their supervisors represent more than a third of total recurrent costs under each strategy (37% and 35% respectively). The CBD strategy was more cost-effective than the FBD strategy: recurrent costs per successful treatment were US$91.8 and US$102.2 respectively.


CONCLUSIONS
Although the CBD strategy was more cost-effective than the FBD strategy in the study context, the estimates of cost-effectiveness were sensitive to relatively small changes in underlying costs and treatment outcomes. Even using these relatively patient-friendly approaches to DOTS, social costs can represent a significant financial burden for TB patients.
Mirzoev
Tolib N
TN
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
Baral
Sushil C
SC
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.|Health Research and Social Development Forum, PO Box 24133, Kathmandu, Nepal.
Karki
Deepak K
DK
Health Research and Social Development Forum, PO Box 24133, Kathmandu, Nepal.|United Nations Population Fund (UNFPA), Nepal, UN House, Pulchowk, Lalitpur, PO Box 107, Kathmandu, Nepal.
Green
Andrew T
AT
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
Newell
James N
JN
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.